Hepatic tuberculosis mimicking metastasis in a case of carcinoma sigmoid colon

Abstract

Tuberculosis (TB) presenting as isolated liver mass without clinical evidence of TB is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver. Hepatic TB associated with carcinoma colon is a rare association which has very rarely been reported in the literature. This case illustrates the diagnostic difficulties of hepatic TB and the need to consider it in the differential diagnosis of hepatic nodular lesions in carcinoma colon patients. Here, we report a case of 48-year-old female who presented in the casualty with features of acute intestinal obstruction. Preoperatively a mass was seen at the hepatic flexure along with three lesions in the liver presumed to be metastatic in origin. However, histopathology of the mass revealed adenocarcinoma colon and the liver lesion proved to be hepatic TB. We wish to highlight that on encountering a hepatic lesion in a carcinoma colon patient the possibility of hepatic TB should also be kept in mind apart from the obvious possibility of metastasis especially in an endemic country like India.

Keywords: Carcinoma colon; hepatic lesion; hepatic tuberculosis.

Figure 1

Hypodense lesion in segment 7 of the liver suggestive of metastasis (a). Hypodense lesion in segment 3 of the liver suggestive of metastasis (b)

Figure 2

Microphotograph showing numerous confluent epithelioid granulomas effacing the normal liver architecture (H and E, ×100) (a). High power view of caseating granuloma with adjacent normal hepatocytes (H and E, ×400) (b). adenocarcinomatous glands with extracellular mucin infiltrating the muscle layer (H and E, ×100) (c). High power view showing glands lined by malignant cells having enlarged hyperchromatic nuclei, coarse chromatin and eosinophilic cytoplasm (H and E, ×400)